Constança Paúl

Psychological distress, loneliness and disability in old age

Abstract With the growth in the number of older people, an increase of mental health problems might be expected. Reducing the amount of suffering and dependence due to poor mental health in old age is a priority requiring a good understanding of the determinants of psychological distress. The objectives were: (a) to measure the prevalence of psychological distress and loneliness in old men and women, living in the community, (b) to clarify the association between psychological distress, health and other explanatory variables and (c) to determine relationship between loneliness and psychological distress. We performed a cross-sectional study of 999 people aged 65+. The variables studied were psychological distress (GHQ-12) and self-reported loneliness. The prevalence of psychological distress was 20%. Illness and disability are related to psychological distress in old age; the feeling of loneliness is the single most important predictor of psychological distress, and not knowing neighbours increases the probability of depression. Attempts to improve detection and management of psychological distress in sick older people, in those who appear isolated and express loneliness should be evaluated.

Psychosocial Profile of Rural and Urban Elders in Portugal

In the scope of the ecology-of-aging paradigm, we studied two different groups of independent elderly living in rural versus urban Portuguese settings. The main objectives were: (1) to develop knowledge on aging in different contexts; (2) to analyze the differences in autonomous behavior, social relationships, psychological satisfaction (e.g., morale), and self-perception of general health and quality of life between rural and urban residents; (3) to contribute to the design of policies for the elderly. We did 1.5h home interviews of 234 elderly (117 rural and 117 urban) to collect socio-demographic data, and access the capacity to perform instrumental activities of daily living (IADL Scale) and life satisfaction (Philadelphia Morale Scale). Although all the subjects were to some extent deprived, results show that the two communities are different in some socio-demographic characteristics such as education level and financial situation (favoring urban elderly), and in their level of autonomy (higher in ru...

Active Ageing: An Empirical Approach to the WHO Model

Background. In the beginning of the 21st century, the world summit on population taking place in Madrid approved active ageing, WHO (2002) as the main objective of health and social policies for old people. Few studies have been done on the scientific validity of the construct. This study aims to validate the construct of active ageing and test empirically the WHO (2002) model of Active Ageing in a sample of community-dwelling seniors. Methods. 1322 old people living in the community were interviewed using an extensive assessment protocol to measure WHOs determinants of active ageing and performed an exploratory factor analysis followed by a confirmatory factor analyses. Results. We did not confirm the active ageing model, as most of the groups of determinants are either not independent or not significant. We got to a six-factor model (health, psychological component, cognitive performance, social relationships, biobehavioural component, and personality) explaining 54.6% of total variance. Conclusion. The present paper shows that there are objective as well as subjective variables contributing to active ageing and that psychological variables seem to give a very important contribute to the construct. The profile of active ageing is expected to vary between contexts and cultures and can be used to guide specific community and individually based interventions.

Older male carers and the positive aspects of care

ABSTRACT Older men are becoming more visible in care-giving research but there are still few studies that focus expressly on the extent to which care-giving has made positive contributions to their life and has been rewarding. Drawing on data from in-depth personal interviews, this Portuguese study analyses the positive statements in the personal descriptions of the care-giving experience of 53 elderly men who were caring for chronically-ill wives. It also explores the differences between the positive references made by the men who were caring for a wife who had dementia and those made by men whose wives had physical impairments. Using open coding and content analysis, positive aspects were identified in 32 of the 53 care-giving situations. The most prevalent themes were ‘satisfaction’ and ‘perceived social honour’. The findings show that positive returns from the caring experience and role were strongly associated with previous good marital relationships and the husbands good self-rated health, and manifested in both specific coping strategies and global and situational meaning-making processes. The study demonstrates that much more can be learnt about the positive dimensions of care in older mens lives, and that such understanding can inform and strengthen formal and therapeutic support.

The concept of 'ageing well' in ten Latin American and European countries

ABSTRACT A review of several studies examining the lay concept of successful ageing and related concepts leads to the conclusion that elders from different cultures appear to agree on most of the components identified in the literature. From the research emerges a multidimensional conceptualisation of ‘successful ageing’ that is described on the basis of physical, emotional, cognitive and social domains, and which coincides with most theoretical and empirical definitions. The main goal of the present research is to study similarities and differences between concepts of ‘successful ageing’ in several Latin American and European countries and in two different age groups, and also to examine whether a similar structure of the lay concept can be found across both continents. The results show minor differences at item levels among countries, continents and age groups, and a similar internal structure across them.

Disability and Psychosocial Outcomes in Old Age

Objective: This article explores psychosocial variables associated with illness and age-related losses during old age. Method: The study is cross-sectional and comprised 999 people aged 65 and older. The variables included health problems and limitations, self-perceptions of health, optimism, and quality of life. Results: In general, people aged 80+ years show high prevalence of health problems and disability, good self-perception of health, and quality of life. However, among the oldest age group, those in better health were more optimistic, but more problems meant lower self-perception of health, quality of life, and optimism. Discussion: This does not fully confirm the disability paradox (high disability and high optimism and self-perception of quality of life). The dual-process coping model helps to understand the results of our study: First is an attempt to avoid losses; afterward, people lower goals and standards to meet constraints and foster adaptation.

Thai Stroke Patient Caregivers: Who They Are and What They Need

Background and Purposes: Primary informal caregivers play a significant role in providing care to stroke survivors after having been discharged from the hospital. Our aims were to describe the characteristics of Thai stroke caregivers and to explore their needs while providing care to their stroke relatives. Methods: Using open-ended questions, we individually interviewed 20 caregivers of stroke survivors to identify their characteristics and their own needs. Additional field notes were made during all interviews. Results: Our findings revealed that the majority of Thai informal stroke caregivers in this study were female, mostly daughters, with the exception of 2 Thai primary stroke caregivers found to be nieces. The majority of caregivers provided care to their stroke relatives 24 h per day. The four major categories of informal rehabilitation were: physical, psychological, social, and spiritual rehabilitation activities. Assistance, information and social support were the three main needs of the caregivers. Conclusion: Based on these findings, appropriate nursing information and assistance focusing on rehabilitation and stroke caregivers’ needs should be provided to Thai stroke caregivers performing informal care to ensure that both patients and caregivers have the best possible quality of life.

Viver com mais idade em contexto familiar: dependência no auto cuidado

A finalidade deste estudo e contribuir para a melhoria da assistencia de enfermagem a pessoa dependente e sua familia. O trabalho teve como objetivos: descrever o grau de dependencia de idosos em contexto familiar; identificar caracteristicas sociodemograficas dos idosos dependentes em contexto familiar; descrever a principal causa que originou a dependencia nos idosos que se encontram no domicilio. A opcao metodologica foi uma abordagem quantitativa de natureza exploratoria descritiva. No periodo de outubro 2007 a junho de 2008 foram seleccionadas 108 familias, de uma regiao norte de Portugal, com um idoso dependente. Foi uma amostra de conveniencia. Para a colheita de informacao recorremos a um inquerito onde incluimos o indice de Barthel. Os resultados mostraram que os idosos sao predominantemente mulheres, viuvas, com media de idade de 81 anos, com nivel grave de dependencia, cuja principal causa foram as doencas do sistema circulatorio.The purpose of this study is to help improve nursing care to dependent people and their families. The study objectives were: to describe the degree of dependency of the elderly in the family context; to identify the sociodemographic characteristics of the dependent elderly in the family context; to describe the main cause of dependency in the aged at home. This is a exploratory, descriptive study with a quantitative approach. In the period comprised between October 2007 and June 2008, 108 families from a northern region of Portugal were selected, with an elderly dependent. It was a convenience sample. For the collection of information, we used a questionnaire with the Barthel Index. Results showed that older people are predominantly women, widows, in average 81 years old, with severe level of dependence, and the leading cause of dependence was circulatory system diseases.

Portuguese version of the Geriatric Anxiety Inventory: Transcultural adaptation and psychometric validation

Objectives: The Geriatric Anxiety Inventory (GAI) is a recently developed anxiety instrument designed to assess the severity of anxiety symptoms across a range of presentations in older adults. In this study, the authors examined the validity of the Portuguese version of the GAI and assessed its psychometric properties. Method: A cross-sectional study was designed using a sample of 152 community-dwelling older adults, and a geriatric psychiatric sample of outpatients with clinical diagnoses of depression (n = 32), anxiety disorders (n = 23), and early Alzheimers disease (n = 10). Results: The Portuguese version of the GAI required linguistic and transcultural adaptations, particularly on the somatic expressions of anxiety. It exhibited sound internal consistency and demonstrated good concurrent validity against the state half of the Spielberg State-Trait Anxiety Inventory, the Geriatric Depression Scale (GDS-30), and the General Health Questionnaire (GHQ-12). The optimal cut-off point to detect severe anxiety symptoms was 8/9, but no optimal cut-off point for Generalized Anxiety Disorder could be estimated. Conclusion: These findings provide initial evidence that the Portuguese version of the GAI is a valid and reliable measure for assessing late-life anxiety and highlights the need for possible modifications of the instrument before being used in other languages and cultural groups.

Risk prediction in the community: A systematic review of case-finding instruments that predict adverse healthcare outcomes in community-dwelling older adults

Few case-finding instruments are available to community healthcare professionals. This review aims to identify short, valid instruments that detect older community-dwellers risk of four adverse outcomes: hospitalisation, functional-decline, institutionalisation and death. Data sources included PubMed and the Cochrane library. Data on outcome measures, patient and instrument characteristics, and trial quality (using the Quality In Prognosis Studies [QUIPS] tool), were double-extracted for derivation-validation studies in community-dwelling older adults (>50 years). Forty-six publications, representing 23 unique instruments, were included. Only five were externally validated. Mean patient age range was 64.2-84.6 years. Most instruments n=18, (78%) were derived in North America from secondary analysis of survey data. The majority n=12, (52%), measured more than one outcome with hospitalisation and the Probability of Repeated Admission score the most studied outcome and instrument respectively. All instruments incorporated multiple predictors. Activities of daily living n=16, (70%), was included most often. Accuracy varied according to instruments and outcomes; area under the curve of 0.60-0.73 for hospitalisation, 0.63-0.78 for functional decline, 0.70-0.74 for institutionalisation and 0.56-0.82 for death. The QUIPS tool showed that 5/23 instruments had low potential for bias across all domains. This review highlights the present need to develop short, reliable, valid instruments to case-find older adults at risk in the community.